Initial management and outcome of aortic endograft limb occlusion

Erzurum, Victor Z.; Sampram, Ellis S.K.; Sarac, Timur P.; Lyden, Sean P.; Clair, Dan; Greenberg, Roy K.; O׳Hara, Patrick J.; Kashyap, Vikram S.; Ouriel, Kenneth

doi:10.1016/j.jvs.2004.06.028

Cited by 52 publications

(31 citation statements)

References 14 publications

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“…1,3,4) The most common clinical presentation of endograft occlusion is acute limb ischemia, including numbness, sensory loss, rest pain, and loss of motor function. The reported incidence of acute limb ischemia is 50%-68%.…”

Section: Resultsmentioning

confidence: 99%

“…1,3,7) Open surgical repair procedures include embolectomy with or without endograft replacement, anatomic bypass, and extra-anatomic bypass, such as femorofemoral crossover bypass and axillofemoral bypass. 1,3,7) If remnant thrombus is expected to remain in an endogarft after successful thrombectomy, additional endograft insertion would have been a preferable treatment option to reestablish the anatomic blood route. 11) We initially tried to open embolectomy; however, the clot in the endograft limbs could not be removed.…”

Section: Discussionmentioning

confidence: 99%

“…Endograft occlusion, a serious late complication following EVAR, has been reported to have an incidence ranging from 1.1% to 7.1%. [1][2][3][4][5][6][7][8][9] Typically, endograft limb occlusion occurs unilaterally. If endograft occlusion occurs acutely in the bilateral limb or the main body of the endograft, its pathological condition may be similar to that of acute occlusion of the abdominal aorta, a emergency treatment.…”

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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“…Grafts lack sufficient support with a weak radial force being a particularly significant cause and kinking is common under these circumstances. Previous studies have also described this problem (13). Excessive oversizing of the graft may lead to infolding of the graft material within the graft lumen (14,15).…”

Section: Discussionmentioning

confidence: 99%

Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort

Wang

Zhai

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR. A total of 61 bifurcated grafts and 5 aortauniilac grafts (127 limbs in total) were used. Physical examination, ankle-brachial-index and computer tomographic angiography were performed at 10 days, at 3, 6 and 12 months and annually thereafter. It was found that 7 limbs in 7 patients (10.6% of patients, 5.5% of limbs) were occluded between 20 days and 12 months (average, 7.8±5.3 months) after EVAR. Acute and severe ischemia was found in 2 cases, claudication was in found 3 cases, asthenia in both legs was found in 1 case and 1 case was asymptomatic. Femoral-femoral bypass, femoral-femoral bypass and stenting, aorto-iliac/femoral bypass, thrombectomy and conservative treatment were performed in 1 patient each and thrombectomy together with stenting was performed in 2 cases. Limb graft occlusion was not rare after EVAR. Treatment of this complication included surgery and endovascular therapy such as bypass, thrombectomy and thrombolysis. In conclusion, aggressive pre-emptive treatment including angioplasty and stenting prevented occlusion in certain cases.

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“…Os tratamentos descritos na literatura para essa complicação incluem: trombectomia com cateter de Fogarty, trombectomia com cateter de Fogarty via bainha 16f seguido de angioplastia com stent primário, trombólise com ou sem implante de stent, trombectomia com sistema reólico Angiojet® (Possis Medical Inc./USA) seguido de implante de stent associado ou não à trombólise, angioplastia com stent primário e procedimentos cirúrgicos abertos anatômicos e extra-anatômicos (ponte femoro-femoral, axilo-femoral e aorto-femoral) 21,22 .…”

Section: Discussionunclassified

Tratamento endovascular da oclusão de ramo ilíaco de endoprótese bifurcada de aorta abdominal: trombectomia rotativa e aspirativa seguida de angioplastia com stent primário

Oliveira¹,

Campedelli²,

Amorelli³

et al. 2012

J. vasc. bras.

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ResumoA oclusão de ramo ilíaco de endoprótese bifurcada de aorta surge como complicação decorrente da correção endovascular do aneurisma de aorta abdominal e várias abordagens terapêuticas têm sido empregadas para o tratamento dessa complicação em casos de isquemia de membro inferior. Apresentamos dois casos de tratamento totalmente percutâneo da oclusão de ramo ilíaco de endoprótese de aorta abdominal com dispositivo de trombectomia rotativa e aspirativa seguida de angioplastia com stent primário, sem complicações operatórias.Palavras-chave: oclusão de enxerto vascular; trombectomia; aneurisma. AbstractIliac limb occlusion of bifurcated aortic stent graft appears as complication of endovascular repair of abdominal aortic aneurysm and several therapeutic approaches have been used to treat this problem in cases of lower limb ischemia. In two cases a totally endovascular approach was used to treat the limb occlusion by means of rotational and aspiration thrombectomy, followed by stenting. In both cases there were no postoperative complications.Keywords: graft occlusion, vascular; thrombectomy; aneurysm. IntroduçãoA correção endovascular do aneurisma de aorta abdominal (CEAAA) foi desenvolvida para um tratamento menos invasivo e com o objetivo de diminuir a morbi/mortalidade do tratamento cirúrgico em pacientes portadores de aneurisma de aorta. Ela tem se mostrado responsável pela redução significativa da taxa de mortalidade operatória, do volume de transfusão sanguínea e do tempo cirúrgico e de internação em unidade de terapia intensiva. Entretanto, requer maior núme-ro de intervenções secundárias para manutenção da exclusão aneurismática e/ou tratamento das complicações [1][2][3][4][5][6] . A intervenção secundária é definida pela Society for Vascular Surgery (SVS) e pela American Association for Vascular Surgery (AAVS) como qualquer procedimento cirúrgico ou endovascular realizado após a correção endovascular inicial 7 . O registro Eurostar 8 classifica as intervenções secundá-rias de acordo com a sua magnitude: 1) necessidade de laparotomia; 2) procedimentos extra-anatômicos; 3) intervenções transfemorais percutâneas ou abertas; todos em busca da padronização para melhor conhecimento e terapia das complicações da CEAAA.

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Initial management and outcome of aortic endograft limb occlusion

Abstract: Both EVA and EB are acceptable management strategies for ELO. The potential risk of graft dislodgement was not observed with an EVA. If EB is employed, assessment of the donor limb and treatment of any underlying lesions is advisable in an attempt to minimize future donor limb occlusion.

Cited by 52 publications

References 14 publications

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort

Tratamento endovascular da oclusão de ramo ilíaco de endoprótese bifurcada de aorta abdominal: trombectomia rotativa e aspirativa seguida de angioplastia com stent primário

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